Surgery
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Although task training on virtual reality (VR) simulators has been shown to transfer to the operating room, to date no VR curricula have been described for advanced laparoscopic procedures. The purpose of this study was to develop a proficiency-based VR technical skills curriculum for laparoscopic colorectal surgery. ⋯ This study used Delphi consensus methodology to create a curriculum for an advanced laparoscopic procedure that is reflective of current clinical practice on an international level and conforms to current educational standards of proficiency-based training.
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In a population-based study, we examined recurrence rates of acute pancreatitis (AP) after cholecystectomy performed to prevent recurrences of AP. ⋯ When AP is associated with significantly elevated liver enzymes on day 1, recurrence rates after cholecystectomy are low (9%). However, postcholecystectomy recurrence rates of AP are high in those without such laboratory abnormalities (34%), especially in those without gall bladder stones/sludge (61%) on abdominal ultrasonography. Our results raise doubts about the efficacy of cholecystectomy to prevent recurrent AP in patients with the absence of either a significant elevation of liver tests on day 1 of AP or gallstones and/or sludge in the gall bladder on initial ultrasound examination.
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In papillary thyroid microcarcinoma (PTMC), regional lymph node metastasis (LNM) is associated with a increased locoregional recurrence rate. Yet, prophylactic central lymph node dissection (CLND) targeting subclinical central LNM continues to be a matter of debate in the treatment of PTMC, which generally carries an excellent prognosis. The aim of our study was to investigate the benefits and risks of prophylactic CLND in patients with clinically node-negative PTMC. ⋯ With prophylactic CLND, the postoperative Tg level can significantly decrease. However, prophylactic CLND is not helpful in decreasing short-term locoregional recurrence in patients with clinically node-negative PTMC. Finally, the risk of permanent hypocalcemia may increase after CLND.
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Comparative Study
Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair.
National outcomes for elective abdominal aortic aneurysm (AAA) repair in elderly populations are needed. The purpose of this study was to analyze outcomes of endovascular (EVAR) and open surgical repair (OSR) of elective AAA among the elderly (≥80 years). ⋯ Although elderly patients have worse outcomes compared with younger patients regardless of approach, endovascular repair among elderly patients is associated with less morbidity and mortality compared with open repair.
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Nationwide rates and patterns of death after surgery are unknown. ⋯ Nationwide reporting on surgical mortality suggests that the number of inpatient deaths within 30 days of surgery has declined. Additional research to determine the underlying causes for decreased mortality is warranted.